The incidence of acute diarrhea in the US is 375 million and mortality is 6,000/year. Acute diarrhea is defined as <14 days per WGO and less than 21 days for ACG. One million hospitalizations are attributed to acute diarrhea per year. Additionally, inappropriate workup and management is associated with a significant financial burden. For example, six studies conducted between 1980 and 1997 showed that the diagnostic yield of stool cultures ranged from 1.5 to 5.6 % and the estimated cost was $9521,200 per stool culture performed.
We performed a retrospective clinical review of patients who visited our hospital during August 2010 to study the following: (1) number of ED visits during August 2010 for acute diarrhea; (2) the number of patients admitted with the following WGO/ACG criteria (dehydration, changing mental status, fevers >101F, dysentry, frequency > 6/day, intractable vomiting, duration >48 h); (3) the number of patients treated with antimicrobial therapy according the following WGO/ACG criteria (dysentery, age >50, modsevere travelers diarrhea (>6 episodes/day), fevers >101, positive stool cultures, fecal leukocyte positive); (4) the percentage of patients who received (CT) scans; and (5) the number of patients who were ordered stool cultures according to WGO/ACG recommendations and the incidence of a positive result. Patients were excluded from the study, if they had a history of IBD, IBS, and/or malabsorptive disease. Also excluded were patients with diarrhea >3 weeks (subacute/chronic), less than 18 years old, and patients with ICD codes that did not correlate with their presenting illness. For each patient, the electronic medical record from ED was reviewed to extract the following data: age, number of stools, dysentery, fevers > 101, symptoms >48 h, dehydration (clinically/vital signs), mental status changes, antimicrobial therapy, CT findings, travel history, fecal leukocytes/fecal occult positive, admitted or discharged, past medical history of IBD, IBS, or malabsorptive diseases.
99 charts were reviewed and 74 patients were included in our study. The admission rate was 25.7% (19/74) and all patients were admitted according to WGO/ACG recommendations. 41.9% (31/74) of patients were given antibiotics, yet 25.6% of patients were given antibiotics not in adherence with WGO/ACG recommendations. 27% received CT scans, with a 75% incidence of a positive colitis finding. CT scans were not indicated in majority. All these patients were treated with antibiotics. Stool cultures were ordered on 24.3%, 66.6% had documented results, zero cultures yielded a positive result, and 83.3% of stool cultures were ordered appropriately according to recommendations.
The majority of our patients were appropriately evaluated and managed, yet 25% of our patients inappropriately received antibiotics and all stool cultures were negative, which may contribute to higher cost and possible antibiotic resistance.
To cite this abstract:Virapongse A, Walczyszyn M, Kothari M, Graham R. Evaluation and Management of Acute Gastroenteritis in a Community Hospital. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97592. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/evaluation-and-management-of-acute-gastroenteritis-in-a-community-hospital/. Accessed March 20, 2019.